J Korean Neurosurg Soc.  2018 Jul;61(4):530-536. 10.3340/jkns.2017.0186.

Rare Intractable Cervicalgia Related to Exaggerated Disc Height Distraction : Report of Two Cases and Literature Review

• Choi MK
• Kim SB
• Lee JH

• KMID: 2417331
• DOI: http://doi.org/10.3340/jkns.2017.0186

Abstract

We present two cases of unexpected postoperative intractable cervicalgia due to over-sized implant insertion during simple anterior cervical decompression and fusion (ACDF) or artificial disc replacement (ADR). These patients experienced severe cervicalgia mostly related to their neck motion even after standard cervical operations. In both cases, the restored disc heights after the operations were prominently greater than the preoperative disc heights. The patients had not responded to any of the conservative treatments, and unloading of these excessively distracted segments through ultimate revision surgery led to dramatic pain relief. This report emphasizes the increase in distractional forces that takes place after a standard ACDF or ADR, as well as the importance of a proper sized implant. It also includes the reviews of other biomechanical or clinical reports dealing with this issue, thereby cautioning the surgeons not to disregard these factors, which might have an adverse effect in patients with cervicalgia even after radiographically successful cervical procedures.

Keyword

Allografts; Total disc replacement; Cervicalgia; Decompression

MeSH Terms

Allografts
Decompression
Humans
Neck
Neck Pain*
Surgeons
Total Disc Replacement

Figure

• 

  Fig. 1. First operation in case 1 : anterior cervical decompression and fusion at C5–6. Pre-operative (A) and post-operative (B) T2-weighted magnetic resonance images with definite evidence of good decompression of preoperative herniated intervertebral disc at the left paracentral.

• 

  Fig. 2. Pre-operative lateral view of the plain radiograph shows the disc height at C5–6 level to be 4.67 mm (A), which overwhelmingly increased to 7.36 mm (B) after cage insertion and fusion.

• 

  Fig. 3. Post-operative lateral plain radiograph shows a well-inserted artificial disc and a decreased disc height of 5.81 mm.

• 

  Fig. 4. First operation in case 2 : artificial disc replacement at C6–7. Preoperative (A) and post-operative (B) T2-weighted magnetic resonance images with definite evidence of good decompression of preoperative herniated intervertebral disc at the right paracentral.

• 

  Fig. 5. Second operation in case 2 : anterior cervical decompression and fusion at C5–6. Post-operative lateral pain radiograph shows a well-inserted cage at C5–6.

• 

  Fig. 6. Pre-operative lateral view of the plain radiograph shows the disc height at C6–7 level to be 5.51 mm (A), which overwhelmingly increased to 7.72 mm (B) after artificial disc insertion.

• 

  Fig. 7. Post-operative lateral plain radiograph shows well inserted artificial disc and change of disc height from 7.72 mm to 6.29 mm.

Reference

References

1. An HS, Evanich CJ, Nowicki BH, Haughton VM. Ideal thickness of smith-robinson graft for anterior cervical fusion. A cadaveric study with computed tomographic correlation. Spine (Phila Pa 1976). 18:2043–2047. 1993.

2. Aryan HE, Newman CB, Lu DC, Hu SS, Tay BK, Bradford DS, et al. Relaxation of forces needed to distract cervical vertebrae after discectomy: A biomechanical study. J Spinal Disord Tech. 22:100–104. 2009.

3. Brodke DS, Zdeblick TA. Modified smith-robinson procedure for anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 17(10 Suppl):S427–S430. 1992.

4. Brower RS, Herkowitz HN, Kurz L. Effect of distraction on union rate of smith-robinson type anterior cervical discectomy and fusion. In : Proceedings of the 20th Annual Meeting of the Cervical Spine Research Society; 1992 Dec; Palm Dessert, CA.

5. Chang H, Baek DH, Choi BW. The relationship between increased intervertebral disc height and development of postoperative axial neck pain after anterior cervical fusion. J Korean Neurosurg Soc. 55:343–347. 2014.

6. Choi MK, Kim SB, Park CK, Lee SH, Jo DJ. Relation of deep paraspinal muscles' cross-sectional area of the cervical spine and bone union in anterior cervical decompression and fusion: a retrospective study. World Neurosurg. 96:91–100. 2016.

7. Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976). 32:2310–2317. 2007.

8. Goffin J, Plets C, Van den Bergh R. Anterior cervical fusion and osteosynthetic stabilization according to caspar: A prospective study of 41 patients with fractures and/or dislocations of the cervical spine. Neurosurgery. 25:865–871. 1989.

9. Ha SM, Kim JH, Oh SH, Song JH, Kim HI, Shin DA. Vertebral distraction during anterior cervical discectomy and fusion causes postoperative neck pain. J Korean Neurosurg Soc. 53:288–292. 2013.

10. Kaiser MG, Haid RW Jr, Subach BR, Barnes B, Rodts GE Jr. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery. 50:229–236. discussion 236-238. 2002.

11. Kwon B, Kim DH, Marvin A, Jenis LG. Outcomes following anterior cervical discectomy and fusion: the role of interbody disc height, angulation, and spinous process distance. J Spinal Disord Tech. 18:304–308. 2005.

12. Miller LE, Block JE. Safety and effectiveness of bone allografts in anterior cervical discectomy and fusion surgery. Spine (Phila Pa 1976). 36:2045–2050. 2011.

13. Nasser R, Yadla S, Maltenfort MG, Harrop JS, Anderson DG, Vaccaro AR, et al. Complications in spine surgery. J Neurosurg Spine. 13:144–157. 2010.

14. Natarajan RN, Chen BH, An HS, Andersson GB. Anterior cervical fusion: a finite element model study on motion segment stability including the effect of osteoporosis. Spine (Phila Pa 1976). 25:955–961. 2000.

15. Olsewski JM, Garvey TA, Schendel MJ. Biomechanical analysis of facet and graft loading in a smith-robinson type cervical spine model. Spine (Phila Pa 1976). 19:2540–2544. 1994.

16. Truumees E, Demetropoulos CK, Yang KH, Herkowitz HN. Effects of disc height and distractive forces on graft compression in an anterior cervical discectomy model. Spine (Phila Pa 1976). 27:2441–2445. 2002.

17. Zhou J, Xia Q, Dong J, Li X, Zhou X, Fang T, et al. Comparison of stand-alone polyetheretherketone cages and iliac crest autografts for the treatment of cervical degenerative disc diseases. Acta Neurochir (Wien). 153:115–122. 2011.